The aim of this application is to develop a patient-oriented mentoring and research program in rheumatic diseases at Baylor College of Medicine. By establishing a comprehensive methodological and content-based program we will provide mentorship and research opportunities to students, fellows, and junior physician and PhD Faculty interested in pursuing independent research careers in Outcomes Research and Clinical Epidemiology in rheumatic diseases. The proposed program will be interdisciplinary in nature and will be facilitated by the interaction between physicians and scientists in the Sections of Health Services Research and Immunology, Allergy and Rheumatology at Baylor College of Medicine. The applicant has MD and PhD degrees and is a rheumatologist and clinical epidemiologist. She is Faculty in both Baylor Sections. Her research interests are in the outcomes of rheumatic diseases, particularly rheumatoid arthritis and osteoarthritis, with an emphasis on the effectiveness of care in these disorders, patient and physician preferences and decision-making processes, and measurement of patient reported outcome in these diseases. The proposed program is based on current grants held by the applicant and the planned continuation projects arising from this research, including: (1) Decision-Making in Joint Replacement - Variations in the use of joint replacement are well documented. The aim of the study is to identify patient and physician determinants of this variation, and to develop evidence-based decision aids to assist patients in their decisions. (2) Treatment Adherence in Patients with Rheumatic Disease - We are conducting a prospective cohort study to evaluate treatment adherence in patients with rheumatoid arthritis and systemic lupus. Preliminary data shows that adherence is problematic. The results of the study will provide the groundwork for an evaluation of a multifaceted intervention to improve adherence. (3) Cognitive Determinants of Outcomes in Total Knee Replacement- Approximately 20-25% of patients undergoing knee replacement are not satisfied with the results, despite technical success. We are evaluating the clinical and psychosocial determinants of this dissatisfaction in a cohort of patients undergoing knee replacement. There is evidence that this may be related to deficient rehabilitation within the first three months after surgery. At the end of the study, we are planning to develop, implement and evaluate a perioperative intervention designed to improve outcomes through goal-setting and various other cognitive techniques. (4) Impact of Patient-Provider Interaction in the Response to Acupuncture in Patients with Knee Osteoarthritis - This is a randomized controlled trial comparing acupuncture and sham acupuncture in the treatment of knee osteoarthritis. The main aim of the study is to evaluate the effects of different patient-provider communication styles on acupuncture and placebo responses.